Cost Fee Research Articles

The impact of the International Atomic Energy Agency (IAEA) program on radiation and tissue banking in Singapore

The National University Hospital (NUH) Tissue Bank was established in October 1988. The National University of Singapore (NUS) was officially appointed by IAEA to be the IAEA/NUS Regional Training Centre (RTC) for RCA Member States for training of tissue bank operators on September 18, 1996. In the first five years since its establishment the National University Hospital Tissue Bank concentrated its work on the sterile procurement and production of deep frozen femoral heads and were used in patients for bone reconstruction. The cost of producing these tissues were about SGD$ 250 per femoral head although cost fees were initially charged at SGD$ 50 per femoral head. The most important activity carried out by Singapore within the IAEA was training. Between November 1997 and April 2007, a total of nine courses were conducted by RTC with a total of 180 tissue bank operators registered, 133 from Asia and the Pacific region (13 countries, including 2 from Iran), 14 from Africa (Zambia, Libya, Egypt, Algeria, and South Africa), 6 from Latin America (Brazil, Chile, Cuba, Peru, and Uruguay), 9 from Europe (Greece, Slovakia, Poland, and Ukraine), and 2 from Australia. The last batch (ninth batch) involved 20 students registered in April 2007 and will be due to sit for the terminal examination in April 2008.

Cost-Effectiveness Analysis in Canada of Dasatinib Versus Imatinib for the Treatment of Chronic Myelogenous Leukemia in Patients with Imatinib Resistance.

Objective: To estimate the cost-utility of dasatinib versus high-dose imatinib (HDI, imatinib 800mg/day) for chronic myelogenous leukemia (CML) in patients with resistance to imatinib at standard doses.Methods: We adapted to the Canadian setting a Markov model with a monthly cycle length that followed hypothetical patients until death. Cost effectiveness was evaluated during three phases of CML: chronic (86% of Ontario patients in 2006), accelerated (9%) and blast crisis (5%). Efficacy of dasatinib and HDI (cytogenetic and hematologic response) and adverse events (AEs) were taken from randomized trials. Canadian costs of medications, laboratory tests, professional fees, hospitalizations, and AEs were obtained from published sources. Societal utility scores were estimated from a Canadian time trade-off study. Analyses were performed from the perspective of the Ontario Ministry of Health. Costs (2006 CDN$) and outcomes (QALYs) were discounted at 5% annually after the first year. Univariate and probabilistic sensitivity analyses were carried out to quantify uncertainty for the incremental cost-effectiveness ratios (ICERs).Results: Dasatinib dominated HDI in chronic phase patients with additional QALYs (3.92 vs. 3.47) and a lower lifetime cost ($379,678 vs. $444,934). The ICERs of dasatinib vs. HDI in accelerated and blast phase were $88,098/QALY and $173,922/QALY respectively. The higher cost/QALY of dasatinib in the advanced phases is explained primarily by the increased predicted survival of dasatinib patients and therefore the longer duration of drug therapy for these patients. Parameters with the greatest influence on results were the time horizon, drug costs and utility values. The interpretation of results remained robust in univariate and probabilistic sensitivity analyses.Conclusion: From an economic perspective dasatinib is an attractive treatment choice for the majority of imatinib resistant CML patients and provides better value for money than HDI.

Audit costs, material weaknesses under SOX Section 404

Purpose – Section 404 of the Sarbanes‐Oxley Act (SOX) of 2002 required companies to report on the effectiveness of their internal controls over financial reporting. Auditors also must attest to, and report on, the assessment of the effectiveness of internal control over financial reporting made by the management of the company being audited. The purpose of this paper is to provide analyses of audit fee costs and material weaknesses reported for companies of different sizes after the effective date of Section 404 and suggest approaches to reduce SOX 404 compliance costs.Design/methodology/approach – Quantitative analysis and deductive reasoning are used to evaluate audit costs associated with Section 404.Findings – Audit fees have been increased substantially, particularly during the first year a company complied with Section 404, and have not been dropped substantially after the first year of compliance. Companies with sales of less than $1 billion reported significantly more material weaknesses than larg...

Cost-Effectiveness Analysis for Computer-Aided Surgical Simulation in Complex Cranio-Maxillofacial Surgery

The purpose of this study is to assess the costs and benefits of computer-aided surgical simulation (CASS) and to compare it with the current surgical planning methods for complex cranio-maxillofacial (CMF) surgery. The comparison of methods applies to all CMF surgeries where the patient's condition is severe enough to undergo a computed tomography scan and a stereolithographic model is necessary for the surgical planning process. The costs for each method can be divided into time and other costs. The time was estimated based on the authors' experience as well as on a survey of a small group of 6 experienced CMF surgeons in the United States. The other costs were estimated based on the authors' experience. CASS has lower costs in terms of surgeon time, patient time, and material costs. Specifically, total surgeon hours spent in planning are 5.25 hours compared with 9.75 for current standard methods. Material and scanning costs are Dollars 1,900 for CASS compared with about Dollars 3,510 for standard methods. Patient time for planning is reduced from 4.75 hours to 2.25 hours with CASS. The reduction in both time and other costs remains when the fixed fee costs of CASS are added to the variable costs. Amortized across the 600 patients per year (1,800 for the assumed 3-year life of the training and software), this adds only a few dollars and a fraction of an hour per surgery. Even in the case of a small clinic when the cost is amortized for 6 patients per year (18 patients for the assumed 3-year life of the training and software), the per surgery costs (9.65 hours and Dollars 2,456) will still favor CASS. Any great new design should consist of at least 2 of the 3 following features: faster, cheaper, and better outcome. This analysis demonstrates that CASS is faster and less costly than the current standard planning methods for complex CMF surgery. Previous studies have also shown that CASS results in better surgical outcomes. Thus, in all regards, CASS appears to be at least as good as the current methods of surgical planning.

Transfer Fee Regulations and Player Development

This paper studies the role of transfer fees in professional sports, where players can commit to binding long-term contracts. They cannot switch clubs before their contract expires unless the old club agrees to let them go; the transfer fee is the price of that agreement. Transfer fees have been defended as a necessary incentive for clubs to invest in training their young players. The apparent absence of significant training costs (compared to the level of transfer fees) has undermined this defense. We present a model without training where an industry of clubs with heterogeneous marginal revenue products for player ability and a population of players with various levels of talent and experience match. Transfer fees are needed to allocate scarce playing opportunities efficiently among players of different levels of known and potential ability. We show that total surplus is lower without transfer fees because playing time gets reallocated towards older players with less upside potential. The resulting increase in player salaries exceeds the transfer fee costs for each level of ability.

Implementing and Assessing the Benefits and Feasibility of a “Safe Sampling” Pilot Project

Background: “Traditional” medication sampling occurs when pharmaceutical companies promote products by providing free samples to physicians, who then pass these on to patients. Limitations of this type of sampling include no pharmacist involvement, limited documentation on patients' medication profiles, limited inventory control in physicians' offices, and lack of patient-specific labeling. We present an improved method called “safe sampling” to mitigate these limitations. Objective: To implement a safe sampling pilot project and to assess its benefits and feasibility from the perspectives of patients, pharmacists, and pharmaceutical company employees. Methods: Physicians provided rabeprazole vouchers to patients in lieu of samples. Patients redeemed the vouchers at the pharmacy for a complimentary seven-day supply. The pharmacist processed the voucher like a prescription. Patients, pharmacists, and pharmaceutical company employees were surveyed after the intervention. Results: The pharmacy received 59 vouchers, which were redeemed by 43 patients and issued by 7 physicians (September 2004—January 2005). The pharmacy filled all vouchers. Of the 42 patients who completed the questionnaires, up to 95% agreed with the various benefits of safe sampling. All pharmacists ( n = 5) and pharmaceutical company employees ( n = 2) agreed that safe sampling was in the patient's best interest and was feasible to implement. Recommendations to enhance safe sampling included involving more than one pharmacy, dispensing medication from existing pharmacy inventory, using online billing, and determining who will pay for safe sampling. Conclusion: All participants acknowledged the benefits of safe sampling. Survey results suggest that pharmaceutical companies may not be willing to absorb the medication cost and/or professional fee involved in dispensing medication samples through pharmacies. Currently, pharmaceutical companies are paying for sample medications and their packaging and distribution. We suggest transferring these funds to the pharmacist's professional fee and sample medication costs. Our surveys suggest that safe sampling is beneficial to patients and is feasible to implement in community practice once the logistics of reimbursement are addressed. Safe sampling provides the groundwork for the creation of a safer, more sustainable method of medication sampling. Additional studies involving a larger patient population, more complex drugs, and a wider selection of pharmacies are needed to further quantify the benefits of safe sampling.

Transfer Fee Regulations and Player Development

This paper studies the role of transfer fees in professional sports, where players can commit to binding long-term contracts. They cannot switch clubs before their contract expires unless the old club agrees to let them go; transfer fee is the price of that agreement. Transfer fees have been defended as a necessary incentive for clubs to invest into training their young players. The apparent absence of significant training costs (compared to the level of transfer fees) has undermined this defense. We present a model without training where an industry of clubs with heterogeneous marginal revenue products for player ability and a population of players with various levels of talent and experience match. Transfer fees are needed to efficiently allocate scarce playing opportunities among players of different levels of known and potential ability. We show that total surplus would be lower without transfer fees because playing time would be reallocated towards older players with less upside potential. The resulting increase in player salaries would exceed the current transfer fee costs for each level of ability. We also study the effects of early termination penalties, transfer taxes, and non-tradable contracts.

Educate, consolidate, immigrate: Educational immigration in Auckland, New Zealand

Abstract: This paper considers the convergence of immigration/globalisation and education in New Zealand. The issues of immigrant students at Epsom Normal Primary School were raised nationally in 1995, and this incident serves as a useful departure point to consider some of the challenges involved in bridging the gap between immigration and education. Educational immigration is a notion used by Belich (2001) amongst others, to suggest that immigrants arrive in New Zealand in order to bypass full cost fees paid by international students. This notion, while useful, is challenged. Research undertaken in North Shore City as well as official immigration figures show the complexities of the issue: immigrant communities may be indirect recruiters of these students, but there are also an increasing number of international students becoming permanent residents. Either way, education providers face particular challenges with migrant students, not only in terms of English language abilities, but also in the lack of financial incentive migrant students give to an education provider relative to international students’ contributions. These micro issues are placed in perspective when returning to considering the transient nature of many young migrants exploring opportunities in a globalised world.

Warfarin in the secondary prevention of thromboembolism in atrial fibrillation: impact of bioavailability on costs and outcomes.

The bioavailability of warfarin is an important factor affecting the achievement of therapeutic anticoagulation. It is uncertain whether less expensive generic preparations of warfarin would compromise prevention of thromboembolism or increase bleeding risk in patients with atrial fibrillation. To compare the cost effectiveness of strategies using warfarin products with variable bioavailability in patients with a prior stroke or transient ischaemic attack related to atrial fibrillation. A Markov decision-analytic model simulating health and economic outcomes over 1 year using the perspective of a government provincial payer was created. Four strategies were compared (where F = 1 is the assumed bioavailability of the branded/reference product): (i) warfarin F = 1; (ii) warfarin F = 1.25; (iii) warfarin F = 0.80; and (iv) alternating warfarin F = 1.25 and 0.80 every other month. Direct medical costs for drugs, physician fees, laboratory testing and hospitalisation for morbid events were obtained from a government payer, a local accounting system and the medical literature. The cost of warfarin F = 1 was equivalent to the cost of the brand name warfarin and the cost of warfarin F not equal 1 was equivalent to generic warfarin. In our institution, warfarin F = 1 was similar in cost to the other three strategies (Can dollars 1361 vs Can dollars 1334-1613) and may be more effective than switching between generic preparations which have bioavailabilities at the extremes of acceptable limits (thromboembolism and bleeds 7. 1% vs 9.3%). In patients with atrial fibrillation and a prior ischaemic stroke or transient ischaemic attack, the use of one warfarin agent within the range of acceptable bioavailability can be considered economically attractive from the healthcare perspective.

Sustainability resources in Swedish townscape neighbourhoods: Results from the model project Hågaby and comparisons with three common residential areas

Seven dynamic aspects of sustainability— resources—were described and monitored thoroughly in a small model community—Hågaby—in west Uppsala, Sweden. The residents’ use of local and distant physical resources, such as heat, electricity, fuel and clean water or production of solid waste and wastewater in the model project were lower than the Swedish average, while the utilisation of local material resources like soil and ground water was higher. Economic resources like houses, equipment, greenery and technical infrastructure were administered and used to minimise costs for construction, maintenance, rents and fees. Social and organisational resources were outlined and managed to facilitate relations between residents and between local professionals in the area. Other goals in the planning of Hågaby, were to facilitate an efficient local as well as distant mobility (transportation and communication) and to organise space for social contact as well as for privacy for individuals and households. Biological, cultural and aesthetic resources were important indirect factors affecting the inhabitants’ feeling of rootedness and their sense of place. All seven resources were managed in its site context to optimise the sustainability of the unique local community. The results from Hågaby were also compared with preliminary data from a new research project investigating sustainability conditions in three common Swedish townscape types in four municipalities. Preliminary results showed that sustainability strengths and weaknesses in several cases indeed differ quantitatively and qualitatively between different typical parts of the city. The results support that the dynamic resource model presented in this paper, should be helpful in establishing place and situation adapted sustainability strategies in any type of Swedish local community.

Using research in practice.

Using research in practice.

A model analysis of costs of blood pressure destabilization and edema associated with rofecoxib and celecoxib among older patients with osteoarthritis and hypertension in a medicare choice population

Economic analyses consider all costs relevant to the use of a particular treatment or treatments. Recently, head-to-head, randomized, controlled trials have shown a significantly higher incidence of blood pressure (BP) destabilization and clinically significant edema with rofecoxib than with celecoxib among older, hypertensive patients with osteoarthritis (OA).The objective of this analysis was to estimate the COX-2 specific inhibitor medication costs, in addition to the costs of drugs and physicians' fees, for BP destabilization and clinically significant edema associated with the use of rofecoxib 25 mg QD and celecoxib 200 mg QD in patients with OA and hypertension in a Medicare Choice population (aged ≥ 65 years).A decision analysis model was constructed to determine the costs (from the payer's perspective) of treating patients in this population with either of the 2 regimens for 6 weeks. The analysis used pooled data from 2 recent, independently conducted, multicenter, double-blind, randomized, controlled trials of OA patients aged ≥ 65 years with treated hypertension who received either celecoxib 200 mg QD or rofecoxib 25 mg QD for 6 weeks. In the individual trials, rofecoxib was associated with significantly higher rates of destabilized BP (P < 0.032 and P < 0.001) and edema (P < 0.01 and P = 0.045) than celecoxib.For a 100,000-member Medicare Choice population, an estimated 25,630 persons would have OA and hypertension (stages I–III), and an estimated 5126 of these patients would use celecoxib or rofecoxib. The estimated costs were $33,938 (6.2%) higher if all hypertensive patients with OA were treated with rofecoxib rather than celecoxib for 6 weeks. The cost per day of use was $0.16 less with celecoxib, and per-patient, per-month costs were $4.79 lower. Celecoxib was a less costly treatment option than rofecoxib among OA patients with hypertension aged ≥ 65 years, based on our model of the direct costs of COX-2 specific inhibitor therapy combined with those associated with physician monitoring and treatment of edema and BP destabilization.

Financing Transport Infrastructure in Developing Country Cities: Evaluation of and Lessons from Nascent Use of Impact Fees in Santiago de Chile

The potential for and limitations to the use of impact fees to finance urban transport infrastructure in developing country cities are assessed, drawing from the specific case of Santiago de Chile. The current state of urban transport infrastructure financing and its inherent complications are first presented. Principles of appropriate impact fee use are then derived from the U.S. experience. These principles are then applied to the recent use of transportation impact fees in Santiago, leading to preliminary recommendations for improvement, including the following: establishing proper overarching legal guidance for their use; taking a uniform approach to their application; clarifying the relationship of impact fees to other user fees and other forms of development exactions; answering the question of who bears the ultimate burden of impact fee costs; and improving the understanding of the effects of transportation impact fees on other public policy goals. From this assessment of the Santiago experience, lessons for other developing country cities are presented.

European Managerial Perceptions of the Net Benefits of Foreign Stock Listings

This study surveys the European managers on the costs, benefits, and net benefits of foreign listing. Increase in prestige and visibility, and growth in shareholders are perceived as the major benefits, and the costs of public relations and legal fees are cited as the major costs by the managers. While a majority of managers (60%) perceive that benefits outweigh the costs of foreign listing, about 30% also view the net benefits to be negative. Perceived net benefits are positively related to the increase in the total trading volume after foreign listing, the financial disclosure levels of the firm, and the dual listing on both the US and European foreign exchanges. Without the influence of these factors, the perceived net benefits are negative.

A new approach to the evaluation of biological treatability of industrial wastewater for the implementation of the “waste design” concept

An intrinsic characteristic of the Italian industrial production system is the presence of several industrial districts with a prevalent manufacturing typology, in which several small and medium enterprises dealing with the same or similar products are concentrated in a small territory. An important textile district is localized in Como area, north of Italy. In many cases, industrial districts are served by large treatment plants that receive the majority of the pollution loading from several small and medium enterprises that do not have internal treatment facilities. The treatment fee is determined by regional regulations; commonly, the single wastewater stream connected to the sewer is billed by the sewer manager to the source industry on the basis of the flow rate and of a complex formula that takes into account a series of parameters. This method is unable to properly evaluate the relationship between treatment fee and actual treatment costs, since conventional physical-chemical and biochemical parameters are not necessarily linked to wastewater treatability. New advanced respirometric methodologies could be used as wastewater characterization techniques, since they are particularly suited to represent the effect of a given wastewater on the final wastewater treatment plant. Hence, they could be better correlated to treatment costs. The instrument developed is composed of two parallel moving bed continuous flow completely mixed reactors of the working volume of about 5 l each, equipped with oxygen sensors connected to a computer that acts as a controller and as a data acquisition and processing unit. Some examples of experimental results obtained with synthetic waste and with real sewage are presented.

A new approach to the evaluation of biological treatability of industrial wastewater for the implementation of the ?waste design? concept

An intrinsic characteristic of the Italian industrial production system is the presence of several industrial districts with a prevalent manufacturing typology, in which several small and medium enterprises dealing with the same or similar products are concentrated in a small territory. An important textile district is localized in Como area, north of Italy. In many cases, industrial districts are served by large treatment plants that receive the majority of the pollution loading from several small and medium enterprises that do not have internal treatment facilities. The treatment fee is determined by regional regulations; commonly, the single wastewater stream connected to the sewer is billed by the sewer manager to the source industry on the basis of the flow rate and of a complex formula that takes into account a series of parameters. This method is unable to properly evaluate the relationship between treatment fee and actual treatment costs, since conventional physical-chemical and biochemical parameters are not necessarily linked to wastewater treatability. New advanced respirometric methodologies could be used as wastewater characterization techniques, since they are particularly suited to represent the effect of a given wastewater on the final wastewater treatment plant. Hence, they could be better correlated to treatment costs. The instrument developed is composed of two parallel moving bed continuous flow completely mixed reactors of the working volume of about 5 l each, equipped with oxygen sensors connected to a computer that acts as a controller and as a data acquisition and processing unit. Some examples of experimental results obtained with synthetic waste and with real sewage are presented.

Social Cost Component of an Efficient Toll

Efficient tolls are tolls that ensure that the price paid by the roadway user is equal to the increment of social and private costs resulting from the highway use. Setting these tolls accomplishes an important objective: to correct the current practice that allows driving to be subsidized by government and nonusers. Without restrictions on vehicle ownership and unlimited access to the nation’s cost-free roadways, drivers do not pay for the social costs they generate. If motorists were required to pay their fair share of these social costs, travel decisions would probably be altered. Unwarranted trips, especially during peak hours, would be reduced because roadway space would be priced to accurately reflect the actual cost of driving. Beyond private costs, society is burdened with paying for infrastructure construction and maintenance, highway services, wasted fuel, pollution, accidents, and congestion costs from travel delays. The cost to society of automobile travel is assessed so that a charge can be made for the social cost component in computing what an efficient toll should be. It is found that the social cost fee during nonpeak travel comes to 0.67¢/vehicle-km (1.08¢/vehicle-mi). Travel during peak periods is far more expensive with the addition of congestion costs. The value of time drives up these costs, and the charges amount to 5.68¢/vehicle-km (9.14¢/vehicle-mi) for peak-period travel.

Potential effects of opportunity cost on dental school patients

Predoctoral clinic fees are set below those of private practices to attract patients. Treatment in a predoctoral clinic requires more and longer appointments and patients spend more time waiting to be seen than in a private practice. This time has a value that economists call opportunity cost, the value of the next best alternative (the hourly wage for an employed patient). A model comparing total cost (fee plus opportunity cost) of treatment in dental schools and private practices for insured and uninsured patients is presented. As patient income increases, the total cost of some treatment plans becomes higher in dental schools than in private practices. To insured patients, however, the out-of-pocket cost of a treatment plan depends on copayments rather than fees. This makes predoctoral clinics less competitive. Considering opportunity cost further increases dental schools' lack of competitiveness. For insured patients, more treatment plans will have a lower total cost in private practice. Clinic directors must realize that if opportunity costs are not reduced, the market may dictate that fees be lowered to remain competitive with private practitioners. They are in competition for patients based on total cost, and efficiencies that reduce opportunity cost may increase revenue and attract patients.

Mechanisms of chronic pain

Chronic pain differs from acute pain in that it serves no useful function, causes suffering, limits activities of daily living, and increases costs of healthcare payments, disability, and litigation fees. Pain perception begins with activation of peripheral nociceptors and conduction through myelinated Aδ and unmyelinated C fibers to the dorsal root ganglion. From here, signals travel via the spinothalamic tract to the thalamus and the somatosensory cortex. Modulation of sensory input (i.e., pain) occurs at many levels. Nociceptors are also neuroeffectors, and transmission can be modulated by their cell bodies, which secrete inflammatory mediators, neuropeptides, or other pain-producing substances. Descending pathways from the hypothalamus, which has opioid-sensitive receptors and is stimulated by arousal and emotional stress, can transmit signals to the dorsal horn that modulate ascending nociceptive transmissions. Modulation to alter the perception of pain also can occur at higher centers (e.g., frontal cortex, midbrain, medulla) by opioids, anti-inflammatory agents, as well as antagonists and agonists of neurotransmitters. This article will review our current knowledge of the mechanisms involved in (1) the transduction of tissue injury or disease signals (nociception and nociceptive receptors); (2) the transmission of signals rostrally to the thalamus and higher nervous system centers (involving perception of the quality, location, and intensity of noxious signals); and (3) the modulation of ascending sensory messages at all levels (periphery, spinal cord, and higher centers).

Ways to think about user fees for federal information products

Abstract With budget cuts looming, Federal agencies are revisiting user fees for information products. The Paperwork Reduction Act of 1995 provides for user fees no higher than the cost of information dissemination. Federal agencies are enjoined from making a profit on their information products and permitted only to recover costs. The real question is how much value agencies should add to their information strictly for the public's use. Practical considerations such as the administrative costs of fees and legal authority to receive revenues condition an agency's decision to begin user fees. Various factors such as allowable costs and differential pricing must be considered in computing users' fees. The author suggests an action strategy for agencies contemplating information user fees and concludes that coming budget cuts will lead to increased employment of user fees by Federal agencies.